Step I Retired NBME Qustion..Please Help..

[Focused1]

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Please explain this question:

http://imgur.com/X7jkVHl

 

[dfib slim]

I'd go with S4. Late diastolic murmur. Blood forced on the stiff hypertrophic ventricle from long standing hypertension.

 

[malin]

Yup agree with above poster; when I hear late diastole, I think S4.

 

[aspiringmd1015]

have to think it out, diastolic murmur at the apex could only mean MS or S4, HTN- diastolic dysfunction, atrium contracting against stiff ventricle: S4

 

[Focused1]

Thanks guys... there is a UW question which says that the bell is used and lateral decubitus position is used to best hear S3... does the same hold true for S4 ?

 

[aspiringmd1015]

I tried messsaging you but your messages cant work, I'm also a Houstonian, Born and raised in Memorial. Wanted to inbox you something